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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005730
Report Date: 02/06/2023
Date Signed: 02/06/2023 12:13:35 PM

Document Has Been Signed on 02/06/2023 12:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:EPJ'S CARE HOMES #2FACILITY NUMBER:
397005730
ADMINISTRATOR:MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:311 MISSION PARK DRTELEPHONE:
(209) 477-4799
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 6CENSUS: 6DATE:
02/06/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Marilyn PatacsilTIME COMPLETED:
12:20 PM
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On 2/6/23 at approximately 10:40am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a health and safety check related to 2 residents that were relocated to the facility. LPA Jensen met with Marilyn Patacsil and explained the purpose of today's visit.

LPA Jensen toured the facility including the grounds, kitchen, bathroom and resident rooms. LPA Jensen interviewed Resident 1 (R1). The bedrooms appeared to be adequately furnished. LPA Jensen confirmed that there is a 2 day supply of perishable food and a 7 day supply of non-perishable food. LPA Jensen observed the medications to be locked and inaccessible to residents in care. LPA Jensen confirmed that the medication for R1 and Resident 2 (R2) was administered as prescribed and adequately documented.

LPA Jensen observed the facility to have medical equipment on hand required by R1. LPA Jensen measured the wheelchair width for R1 to be approximately 27 inches and measured the bathroom door width to be approximately 26 inches. LPA Jensen will be on contact with the regional center to discuss this matter further.

No citations are being issued as a result of this visit. An exit interview was conducted and a copy of this report was provided.


SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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